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Biomedical subjects

J C Türp

Publications and source records attributed to J C Türp.

At least 19 recordsLinked to original sources
PubMed2007

[Therapy of masticatory muscle pain: recommendations for clinical management].

Myalgias of the masticatory muscles are the most frequent noninfectious complaints in the orofacial region. After summarizing the current knowledge on the physiology, etiology, pathophysiology, diagnosis, and differential diagnosis of masticatory muscle pain, we specifically focus on management recommendations. Results of an extensive literature search show that for the majority of patients pain reduction or pain relief can be achieved with noninvasive reversible methods. Longitudinal short- and long-term studies have revealed that different therapeutic measures are similarly effective. In patients with chronic masticatory myalgias associated with psychosocial impairment, however, additional involvement of a psychotherapist is crucial.

Analgesics↗
PubMed2006

[Recommendations for the standardized evaluation and classification of painful temporomandibular disorders: an update].

BACKGROUND: In 2000, the interdisciplinary Working Group of Orofacial Pain within the German Chapter of the IASP (German Association for the Study of Pain) published recommendations for the standardized evaluation and diagnostic classification of patients with painful masticatory muscles and/or temporomandibular joints. The purpose of the present study was to critically review and update these recommendations. RESULTS: Appraisal of the relevant literature published after the release of the recommendations (up to December 2005) shows that the two-axis approach for the assessment of the somatic and psychosocial parameters of the orofacial pain experience has found wide support. Single aspects of the recommendations have been substantiated by additional scientific evidence. CONCLUSIONS: The recommendations reflect the current state of pain medicine. Therefore, they should be considered among practitioners who diagnose and manage patients suffering from temporomandibular disorders.

Germany↗
PubMed2006

[Pain drawings of patients with orofacial pain. Comparison of acceptance and gain of information].

AIM OF THE STUDY: The aim of this prospective multicentric study was to compare two different types of pain drawings in terms of acceptance and gain of information in patients with orofacial pain. PATIENTS AND METHODS: A total of 204 patients from 9 centers, who visited their dentist or physician for orofacial pain, received two different diagrams for pain drawings in random order. One was the original pain diagram of the Deutsche Schmerzfragebogen (German Pain Questionnaire, diagram A), and the other diagram had been developed to achieve a symmetrical representation of the body and to allow computer-assisted analysis (diagram B). This diagram was larger and contained a drawing of the head. The patients' answers were analyzed for the preference between diagrams, the number and distribution of pain areas, and the concordance between the diagrams. The results were correlated with the patients' data. RESULTS: Data from 183 patients could be analyzed: 100 of 183 patients preferred diagram B and 57 of 183 preferred diagram A, independent of gender, age, or duration of disease. Most patients reported pain in more than one area; in only 43 of 183 patients was the pain limited to the face and head. The number and distribution of pain areas were not different between the two pain diagrams. CONCLUSIONS: Detailed head and body diagrams can be used in the diagnostic evaluation of patients with orofacial pain without fear of placing excessive demands on the patients and are useful for detecting comorbidities.

Art↗
PubMed2006

Asymmetry of the articular eminence in dentate and partially edentulous populations.

The purpose of this study was to assess the degree of right-left asymmetry of the glenoid fossa. The specific aims were (1) to determine whether there were relationships between age, number of teeth, slope of the articular eminence, fossa depth, and the degree of right-left asymmetry, and (2) to compare the right-left asymmetry of two populations, one characterized by an acceptable occlusion (A-Occ), the other by an unacceptable occlusion (partially edentulous; Un-Occ). A-Occ was defined as possessing a minimum of 28 teeth that would allow for hand articulation of the mandibular teeth to the maxillary teeth. Un-Occ had fewer than 17 teeth, which would make it impossible to articulate the mandible with the maxilla. The sample included 20th century dry skulls: 70 African-American (44 male, 26 female) and 64 European-American (49 male, 15 female), ranging in age from 21-105 (mean 47.1 +/- 19.9). The medial (M), central (C), and lateral (Lat) aspects of the right (R) and left (L) slopes of the articular eminence were measured in a sagittal plane. The R and L fossa depth also were measured. The raw absolute differences IR-LI and relative differences [IR-LI/IR+Llx100] of the articular slope angles (M, C, and Lat) and fossa depths were computed. Statistical analysis included paired t-tests, independent t-tests, and Pearson's correlation coefficients, significance at p < or = 0.05. Ninety percent (90%) of the population exhibited right-left asymmetry of the glenoid fossa. The right articular slopes (M, C, and Lat) were significantly steeper than the left articular slopes; the right fossa depths were significantly deeper than the left. There generally were no differences in the articular slope steepness or fossa depths between the partially dentate and the dentate, nor were there statistical differences between the two groups in the raw absolute differences or relative differences of the M, C, and Lat slopes or fossa depths. No significant relationships were found between right-left asymmetry, age, or number of teeth. With only 10% of the subjects exhibiting symmetry of the glenoid fossa depths or articular slope angles, clinicians should consider bilateral asymmetry the norm and not an anomaly.

Adult↗
PubMed2005

Is the posterior belly of the digastric muscle palpable? A qualitative systematic review of the literature.

Palpation of the posterior belly of the digastric muscle in the postmandibular region is included in many study protocols and examination schemes of the masticatory system. The aim of the present investigation was to systematically search the dental/medical literature to find evidence for the palpability of this muscle. In August 2004, a systematic search was carried out using different electronic databases (PubMed, Cochrane Library, Web of Science, Japana Centra Revuo Medicina, MedPilot, Latin American and Caribbean Health Sciences, and three on-line databases of dental journals not listed currently in Medline), supplemented by manual search in the Austrian journal Stomatologie. Additional manual searches were carried out in the Journal of Orofacial Pain and Journal of Dental Research to identify pertinent abstracts of scientific congresses. One relevant hit was found in the Japanese database. The manual search showed one pertinent congress abstract. In both publications, the authors concluded that due to anatomical reasons the posterior belly of the digastric muscle was not palpable. Hence, evidence is lacking that the posterior digastric muscle is accessible to palpation. Because the postmandibular region is usually tender upon palpation, a high incidence of positive findings can be expected even among healthy subjects. This may lead to wrong clinical judgments, possibly provoking unnecessary diagnostic and therapeutic measures.

Humans↗
PubMed2005

Evidence-based dentistry in German-language dental journals 1997-2003.

The purpose of this systematic literature search was to evaluate how the evidence-based approach appears in German-language dental journals. All volumes of 28 dental journals published between 1997 and 2003 were searched by hand; for 15 of these journals, an additional electronic search was made. The focus of the search was all articles, editorials or letters to the Editor dealing with topics related to evidence-based dentistry (EBD)/medicine or using its terminology. Of the 1776 journal issues that were scrutinised, 368 relevant publications were found. After a low, albeit slightly increasing, number of pertinent contributions published between 1997 and 1999, there was a sharp rise in 2000 and 2001, culminating in 2003. Our findings indicate a rising awareness of the concept of EBD in the German-language dental literature. Nonetheless, its reception within the German-speaking dental community is still modest.

Dentistry↗
PubMed2005

Is there a greater mandibular movement capacity towards the left? Verification of an observation from 1921.

In 1921, the German dentist Hans Wertheim reported that more individuals were able to shift the mandible more towards the left than to the right. This study analyses the deviation from symmetrical mobility of the lower jaw in either direction. Using a millimetre ruler, maximum jaw opening (MJO), maximum left laterotrusion (MLL), and maximum right laterotrusion (MRL) were recorded in 141 healthy individuals and in 141 patients with temporomandibular disorders (TMDs). For both sexes, the mean maximum movements to the left and to the right were greater in the healthy group as compared with the TMD group. Healthy subjects as well as patients were able to move the mandible more to one side. Only a minority had identical values for MLL and MRL. The majority of healthy individuals and TMD patients could move more to the left (P < 0.001). In the healthy group, the mean ratio between MJO and MLL was 5.0, and 5.5 between MJO and MRL. In the TMD group, the corresponding values were 4.6 and 6.1. The mean absolute difference between MLL and MLR (in mm) was 1.24 [95% confidence interval (CI): 0.99; 1.49] among healthy females, and 2.09 (95% CI: 1.52; 2.66) among healthy males. In the TMD group, the corresponding values were 2.62 (95% CI: 2.21; 3.04) and 2.83 (95% CI: 1.67; 4.00), respectively. From the results of our study we conclude that moderate deviations from symmetric movements (mean: 1.2 mm for women, 2.1 mm for men) appear to be the norm even in healthy individuals.

Adult↗
PubMed2005

Differential activity patterns in the masseter muscle under simulated clenching and grinding forces.

The aim of this study was to investigate (i) whether the masseter muscle shows differential activation under experimental conditions which simulate force generation during clenching and grinding activities; and (ii) whether there are (a) preferentially active muscle regions or (b) force directions which show enhanced muscle activation. To answer these questions, the electromyographic (EMG) activity of the right masseter muscle was recorded with five intramuscular electrodes placed in two deep muscle areas and in three surface regions. Intraoral force transfer and force measurement were achieved by a central bearing pin device equipped with three strain gauges (SG). The activity distribution in the muscle was recorded in four different mandibular positions (central, left, right, anterior). In each position, maximum voluntary contraction (MVC) was exerted in vertical, posterior, anterior, medial and lateral directions. The investigated muscle regions showed different amount of EMG activity. The relative intensity of the activation, with respect to other regions, changed depending on the task. In other words, the muscle regions demonstrated heterogeneous changes of the EMG pattern for the various motor tasks. The resultant force vectors demonstrated similar amounts in all horizontal bite directions. Protrusive force directions revealed the highest relative activation of the masseter muscle. The posterior deep muscle region seemed to be the most active compartment during the different motor tasks. The results indicate a heterogeneous activation of the masseter muscle under test conditions simulating force generation during clenching and grinding. Protrusively directed bite forces were accompanied by the highest activation in the muscle, with the posterior deep region as the most active area.

Adult↗
PubMed2004

Efficacy of stabilization splints for the management of patients with masticatory muscle pain: a qualitative systematic review.

This study aimed at providing an answer to two clinical questions related to patients with masticatory muscle pain: 1) Does the use of a full-coverage hard acrylic occlusal appliance (stabilization splint) lead to a significant decrease of symptoms? and 2) Is the treatment success achieved with a stabilization splint more pronounced than the success attained with other forms of treatment (including placebo treatment) or no treatment? A systematic search was carried out in different electronic databases, supplemented by handsearch in four selected dental journals and by examination of the bibliographies of the retrieved articles. Thirteen publications, representing nine controlled clinical studies, could be identified. Reporting quality of most studies as assessed with the Jadad score ranged from 1 to 5. Based on the currently best available evidence it appears that most patients with masticatory muscle pain are helped by the incorporation of a stabilization splint. Nevertheless, evidence is equivocal if improvement of pain symptoms after incorporation of the intraoral appliance is caused by a specific effect of the appliance. A stabilization splint does not appear to yield a better clinical outcome than a soft splint, a non-occluding palatal splint, physical therapy, or body acupuncture. The scarcity of current external evidence emphasizes the need for more and better clinical research.

Clinical Trials as Topic↗
PubMed2004

[Chronic temporomandibular disorders].

According to the 3rd German Oral Health Study (1999), the prevalence of painful temporomandibular disorders (TMDs) is about 5%. Although limited information about the magnitude of utilization of health care services and expenses for health care in temporomandibular pain patients is available, the financial burden of affected individuals may be considerable. The etiology and pathophysiology of chronic TMDs is still obscure. However, certain (patho)physiological mechanisms may be associated with the genesis and perpetuation of these musculoskeletal facial pains (e. g. disturbances in central nervous system processing; psychosocial factors; hormonal influences). Strong scientific evidence from the dental/medical literature is currently available for the following forms of TMD treatment and management: occlusal appliances (stabilization appliance), clonazepam, diazepam, meprobamate, EMG biofeedback, multimodal approaches (somatic and psychological pain management).

Chronic Disease↗
PubMed2004

[Functional somatic pain syndromes-nomenclature].

A significant number of pain syndromes to be found in all medical specialties, including pain therapy, can be ascribed to a group that according to the classification of the International Association for the Study of Pain (IASP) is referred to as "pain syndromes with dysfunctional etiology," or according to internal medical terminology as "functional somatic syndromes" (functional disorders), or based on psychiatric nomenclature as "somatoform disorders." Frequent syndromes exhibiting pain as the major symptom include fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), chronic pelvic pain (CPP), tension headache, chronic myoarthropathies of the masticatory system (MAP), and prostatodynia. It is important for practitioners of both somatic and psychosocial medicine to be aware of the terminology used in other fields and the frequency of comorbidities of the individual syndromes. To improve communication between somatic and psychosocial medicine as well as with patients, the authors recommend that pain therapists base their diagnosis on the ICD-10 classification and refrain from using a separate pain therapy nomenclature.

Diagnosis, Differential↗
PubMed2004

[Initial consultation between physician and patients with chronic facial pain].

BACKGROUND: For various reasons, the initial medical (dental) consultation with patients suffering from chronic pain often does not meet the needs of a "medical dialogue." The aim of this study was to determine whether additional, diagnostically relevant information could be gained from a nonmedical interview. METHODS: The initial dental consultation and an additional conversation with a linguist were taped, transcribed, and compared regarding information obtained. RESULTS: During the interview with the linguist, additional information was provided pertaining to all important aspects of the patient's history that had not been mentioned during the consultation with the physician. This was particularly prominent with regard to the subjects of "complaint history," "impairment/extent of distress," and "biopsychosocial history," for which four to ten times more keywords were mentioned to the linguist than to the physician. CONCLUSION: The result of this study emphasizes the need for improvement of the dentist's method for taking history to diagnose chronic pain and if necessary arrange an additional interview with a medical layman.

Chronic Disease↗
PubMed2004

[Functional somatic pain syndromes: summary of hypotheses of their overlap and etiology].

Currently it is unclear whether functional somatic syndromes can be explained by one common underlying functional syndrome. In any case it does not seem justified to view functional somatic syndromes as purely psychological disorders (somatized anxiety or depression). Psychiatric comorbidity and life time stress including traumatisations are mainly, but not exclusively responsible for triggering health care utilisation. The lowered pain threshold that can be demonstrated clinically and experimentally in fibromyalgia, irritable bowel syndrome, tension headache and temporomandibular disorders is currently seen primarily as result of an altered central nervous processing of nociceptive input. In addition some results also hint at a disturbance in the hypothalamus-pituitary-adrenal axis. The predominance of female patients can be due to gender specific illness behaviour as well as to estrogen-induced changes in pain sensitivity. In sum, functional somatic syndromes currently are best explained by a biopsychosocial model of predisposing, triggering and maintaining factors. More research is needed particularly to clarify the role of genetic and of cultural factors.

Chronic Disease↗
PubMed2003

[Myoarthropathy of the temporomandibular joint and masticatory muscles. Pain therapy management and relaxation instead of aggressive surgery].

Temporomandibular pain is often characterized by a mismatch between symptoms and findings. The dentist's well-established therapeutic strategies for the management of acute pain are therefore frequently not effective in patients with painful temporomandibular disorders (TMD). Instead, dentists should apply the tried and tested principles that are applied in general medicine to the diagnosis and treatment of musculoskeletal pain (e.g. arthritic pain or fibromyalgia). When consulted by patients with rheumatic diseases, physicians should routinely enquire whether they also experience temporomandibular pain.

Analgesics↗
PubMed2003

["Facial pain" in German-language medical textbooks on pain (1990-2002)].

INTRODUCTION: The aim of this study was to determine how frequently and to what extent facial pain--particularly musculoskeletal and neuropathic pain--has been considered in German-language textbooks on pain published between 1990 and 2002. METHODS: Relevant textbooks were identified by hand search and by search in electronic bibliographic databases. A quantitative analysis was carried out by counting and comparing the number of pertinent pages in the textbooks. For the assessment of the medical-scientific quality of the information on musculoskeletal face pain, a checklist was used based on comparisons with the current state of the scientific literature on facial pain. RESULTS: Of 231 textbooks on pain, 28 consider the topic of "facial pain." Of the 1923 pages dedicated to facial pain and headache, musculoskeletal and neuropathic facial pain make up 7% and 17%, respectively. Headache, in contrast, accounts for 71% of all pages. Only ten contributions on musculoskeletal facial pain could be assessed, two of which exhibit a high medical-scientific quality. CONCLUSIONS: The data suggest that facial pain is underrepresented in German-language textbooks on pain. In addition, a considerable part of the information given on musculoskeletal facial pain does not correspond to the current state of the scientific literature. This may lead to under- or overdiagnosis and to under- or overtreatment.

Facial Pain↗